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Grandahl, M., Nevéus, T., Dalianis, T., Larsson, M., Tydén, T. & Stenhammar, C. (2019). ‘I also want to be vaccinated!’ – adolescent boys’ awareness and thoughts, perceived benefits, information sources, and intention to be vaccinated against Human papillomavirus (HPV). Human Vaccines & Immunotherapeutics, 15(7-8), 1794-1802
Open this publication in new window or tab >>‘I also want to be vaccinated!’ – adolescent boys’ awareness and thoughts, perceived benefits, information sources, and intention to be vaccinated against Human papillomavirus (HPV)
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2019 (English)In: Human Vaccines & Immunotherapeutics, ISSN 2164-5515, E-ISSN 2164-554X, Vol. 15, no 7-8, p. 1794-1802Article in journal (Refereed) Published
Abstract [en]

This study investigates boys’ awareness and thoughts about human papillomavirus (HPV) and HPV vaccination, perceived benefits of vaccinating men, information sources and intention to be vaccinated against HPV. We used a qualitative approach and interviews were conducted with 31 upper secondary school male students. Two main themes 1) Promotion of equal health and 2) Increased knowledge facilitates the decision about HPV vaccination emerged from the analysis. The informants believed that it was important and fair to protect boys and girls equally against HPV. If HPV vaccination could prevent both girls and boys against an HPV-related disease, there was nothing to question or to discuss. It was not a matter of sex; it was a matter of equal rights. Moreover, an important reason for vaccinating boys was to prevent the transmission of the virus. However, the boys felt unsure and stated that they needed to know more. The school nurse and the school health were considered suitable both for distributing information and for providing the vaccinations.

In conclusion, the participants were in favor of introducing HPV vaccination also for boys in the national vaccination program. Sex-neutral HPV vaccinations were viewed both as a way to stop the virus transmission and a means to promote equal health for the entire population.

Keywords
Awareness, boys, equal health, gender neutral vaccination, health belief model, human
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-371524 (URN)10.1080/21645515.2018.1551670 (DOI)000482271400045 ()30481108 (PubMedID)
Funder
Swedish Cancer Society, 130744
Available from: 2018-12-21 Created: 2018-12-21 Last updated: 2019-10-18Bibliographically approved
Grandahl, M., Bodin, M. & Stern, J. (2019). In everybody's interest but no one's assigned responsibility: midwives' thoughts and experiences of preventive work for men's sexual and reproductive health and rights within primary care. BMC Public Health, 19, Article ID 1423.
Open this publication in new window or tab >>In everybody's interest but no one's assigned responsibility: midwives' thoughts and experiences of preventive work for men's sexual and reproductive health and rights within primary care
2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 1423Article in journal (Refereed) Published
Abstract [en]

Background: Sexual and reproductive health and rights (SRHR) have historically been regarded as a woman's issue. It is likely that these gender norms also hinder health care providers from perceiving boys and men as health care recipients, especially within the area of SRHR. The aim of this study was to explore midwives' thoughts and experiences regarding preventive work for men's sexual and reproductive health and rights in the primary care setting.

Methods: An exploratory qualitative study. Five focus group interviews, including 4-5 participants in each group, were conducted with 22 midwives aged 31-64, who worked with reproductive, perinatal and sexual health within primary care. Data were analysed by latent content analysis.

Results: One overall theme emerged, in everybody's interest, but no one's assigned responsibility, and three sub-themes: (i) organisational aspects create obstacles, (ii) mixed views on the midwife's role and responsibility, and (iii) beliefs about men and women: same, but different.

Conclusions: Midwives believed that preventive work for men's sexual and reproductive health and rights was in everybody's interest, but no one's assigned responsibility. To improve men's access to sexual and reproductive health care, actions are needed from the state, the health care system and health care providers.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Equal health, Gender norms, Health care providers, Health promotion, Men, Midwives, Sexual and reproductive health and rights, Social model of health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-400417 (URN)10.1186/s12889-019-7792-z (DOI)000499680900007 ()31666036 (PubMedID)
Available from: 2020-01-02 Created: 2020-01-02 Last updated: 2020-01-02Bibliographically approved
Grandahl, M., Paek, S. C., Grisurapong, S., Sherer, P., Tydén, T. & Lundberg, P. (2018). Correction: Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs. PLoS ONE, 13(4), Article ID e0196437.
Open this publication in new window or tab >>Correction: Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs
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2018 (English)In: PLoS ONE, E-ISSN 1932-6203, Vol. 13, no 4, article id e0196437Article in journal (Refereed) Published
Abstract [en]

[This corrects the article DOI: 10.1371/journal.pone.0193054.].

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-374332 (URN)10.1371/journal.pone.0196437 (DOI)29672648 (PubMedID)
Available from: 2020-02-26 Created: 2020-02-26 Last updated: 2020-02-26
Ekstrand Ragnar, M., Grandahl, M., Stern, J. & Mattebo, M. (2018). Important but far away: adolescents' beliefs, awareness and experiences of fertility and preconception health. European journal of contraception & reproductive health care, 23(4), 265-273
Open this publication in new window or tab >>Important but far away: adolescents' beliefs, awareness and experiences of fertility and preconception health
2018 (English)In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 23, no 4, p. 265-273Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim was to explore adolescents' beliefs and awareness regarding fertility and preconception health, as well as their views and experiences of information about fertility and preconception health directed at their age group.

Methods: We performed seven semi-structured focus group interviews among upper secondary school students (n = 47) aged 16-18 years in two Swedish counties. Data were analysed by qualitative content analysis.

Results: One theme ('important but far away') and five categories ('starting a family far down on the list'; 'high awareness but patchy knowledge of fertility and preconception health'; 'gender roles influence beliefs about fertility and preconception health'; 'wish to preserve fertility and preconception health in order to keep the door to procreation open'; 'no panacea - early and continuous education about fertility and preconception health') emerged from the interviews. Participants recognised the importance of preconception health and were highly aware of the overall importance of a healthy lifestyle. Their knowledge, however, was patchy and they had difficulties relating to fertility and preconception health on a personal and behavioural level. Participants wanted more information but had heterogeneous beliefs about when, where and how this information should be given.

Conclusion: The adolescents wanted information on fertility and preconception health to be delivered repeatedly as well as through different sources.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
Adolescents, fertility awareness, focus group discussion, preconception health
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-368770 (URN)10.1080/13625187.2018.1481942 (DOI)000446985600004 ()30010448 (PubMedID)
Available from: 2018-12-10 Created: 2018-12-10 Last updated: 2019-10-18Bibliographically approved
Grandahl, M., Paek, S. C., Grisurapong, S., Sherer, P., Tydén, T. & Lundberg, P. (2018). Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand. PLoS ONE, 13(2), Article ID e0193054.
Open this publication in new window or tab >>Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs: A cross-sectional study in Thailand
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 2, article id e0193054Article in journal (Refereed) Published
Abstract [en]

Thailand has one of the world's highest prevalence of cervical cancer, mainly caused by the human papillomavirus (HPV). HPV infections can successfully be prevented by vaccination, which is available at a cost but not yet implemented in the national vaccination program. Parents play a critical role in deciding whether to vaccinate their child against HPV. Thus, the aim was to examine the association between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. A cross-sectional design was used among three schools in Thailand: Nakorn Phatom province (suburban) and Bangkok (urban). Parents of 9-12-year-old daughters completed the questionnaires, guided by the Health Belief Model. In total, 359 parents completed the questionnaires; of those, 301 were included in the final analyses. The ordinary least squares (OLS) regression analysis showed that background knowledge of HPV and the HPV vaccine was positively related to knowledge of HPV and cervical cancer. For beliefs, knowledge was positively associated with susceptibility (i.e., parents' perceived risk of an HPV infection/related disease), severity, and benefit. However, knowledge was not significantly related to barriers. For acceptance, higher susceptibility and benefit were related to higher acceptance, and greater knowledge was associated with higher acceptance. Thus, we found associations between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. Parents, who reported religion as important, as opposed to those who did not, were more favorable toward the HPV vaccination. Four out of ten mothers had never undergone a cervical cancer screening, but most had accepted previous childhood vaccinations for their daughters. The overall acceptance of the vaccine was high, and we believe our results are promising for future implementation of the HPV vaccination in the national childhood vaccination program in Thailand.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-348918 (URN)10.1371/journal.pone.0193054 (DOI)000425283900104 ()29447271 (PubMedID)
Funder
The Swedish Foundation for International Cooperation in Research and Higher Education (STINT), IB2014-5900
Available from: 2018-04-25 Created: 2018-04-25 Last updated: 2019-10-18Bibliographically approved
Grandahl, M., Larsson, M., Dalianis, T., Stenhammar, C., Tydén, T., Westerling, R. & Nevéus, T. (2017). Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour. PLoS ONE, 12(11), Article ID e0187193.
Open this publication in new window or tab >>Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 11, article id e0187193Article in journal (Refereed) Published
Abstract [en]

In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolescents' knowledge, beliefs and HPV vaccination status in relation to socioeconomic status and sexual experience. Thus, the aim was to examine HPV catch-up vaccination status in adolescents in relation to 1) socioeconomic factors, 2) beliefs and knowledge about HPV prevention, and 3) sexual behaviour. The Health Belief Model was used as a theoretical framework. Upper secondary school students (n = 832) aged 16, randomly chosen from a larger sample, were invited to participate in conjunction with the general health interview with the school nurse. A total of 751/832 (90.3%), girls (n = 391, 52%) and boys (n = 360, 48%) completed the questionnaire. HPV vaccination was associated with ethnicity and the mothers' education level; i.e. girls with a non-European background and girls with a less educated mother were less likely to have received the vaccine (p<0.01 and p = 0.04 respectively). Vaccinated girls perceived HPV infection as more severe (p = 0.01), had more insight into women's susceptibility to the infection (p = 0.02), perceived more benefits of the vaccine as protection against cervical cancer (p<0.01) and had a higher intention to engage in HPV-preventive behaviour (p = 0.01). Furthermore, boys and girls were almost equally sexually experienced, although fewer girls had used condom during first intercourse with their latest partner (p = 0.03). Finally, HPV vaccinated girls were less likely to have unprotected sex (p<0.01). In summary, catch-up HPV vaccination among young girls was associated with a European background and high maternal education level, as well as more favourable beliefs towards HPV prevention and less sexual risk-taking. Further preventive measures should therefore be directed at the migrant population.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-333214 (URN)10.1371/journal.pone.0187193 (DOI)000414377900014 ()29099839 (PubMedID)
Projects
Prevention of Human Papillomavirus in a school-based setting
Funder
Swedish Cancer Society, 130744
Available from: 2017-11-08 Created: 2017-11-08 Last updated: 2019-10-18Bibliographically approved
Gottvall, M., Stenhammar, C. & Grandahl, M. (2017). Parents' views of including young boys in the Swedish national school-based HPV vaccination programme: a qualitative study. BMJ Open, 7(2), Article ID e014255.
Open this publication in new window or tab >>Parents' views of including young boys in the Swedish national school-based HPV vaccination programme: a qualitative study
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 2, article id e014255Article in journal (Refereed) Published
Abstract [en]

Objective: To explore parents' views of extending the human papillomavirus (HPV) vaccination programme to also include boys. Design: Explorative qualitative design using individual, face-to-face, interviews and inductive thematic analysis. Setting: 11 strategically chosen municipalities in central Sweden. Participants: Parents (n= 42) who were offered HPV vaccination for their 11-12 years old daughter in the national school-based vaccination programme. Results: The key themes were: equality from a public health perspective and perception of risk for disease. Parents expressed low knowledge and awareness about the health benefits of male HPV vaccination, and they perceived low risk for boys to get HPV. Some parents could not see any reason for vaccinating boys. However, many parents preferred gender-neutral vaccination, and some of the parents who had not accepted HPV vaccination for their daughter expressed that they would be willing to accept vaccination for their son, if it was offered. It was evident that there was both trust and distrust in authorities' decision to only vaccinate girls. Parents expressed a preference for increased sexual and reproductive health promotion such as more information about condom use. Some parents shared that it was more important to vaccinate girls than boys since they believed girls face a higher risk of deadly diseases associated with HPV, but some also believed girls might be more vulnerable to side effects of the vaccine. Conclusions: A vaccine offered only to girls may cause parents to be hesitant to vaccinate, while also including boys in the national vaccination programme might improve parents' trust in the vaccine. More information about the health benefits of HPV vaccination for males is necessary to increase HPV vaccination among boys. This may eventually lead to increased HPV vaccine coverage among both girls and boys.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-320497 (URN)10.1136/bmjopen-2016-014255 (DOI)000397872400135 ()28246143 (PubMedID)
Funder
Swedish Cancer Society, 130 744
Available from: 2017-04-20 Created: 2017-04-20 Last updated: 2019-10-18Bibliographically approved
Grandahl, M., Larsson, M., Tydén, T. & Stenhammar, C. (2017). School nurses' attitudes towards and experiences of the Swedish school-based HPV vaccination programme - A repeated cross sectional study. PLoS ONE, 12(4), Article ID e0175883.
Open this publication in new window or tab >>School nurses' attitudes towards and experiences of the Swedish school-based HPV vaccination programme - A repeated cross sectional study
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 4, article id e0175883Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate school nurses' attitudes towards, and experiences of vaccination against human papillomavirus (HPV), and compare the results with a similar study three years earlier. School nurses (n = 736) from all counties in Sweden completed a questionnaire in spring 2016, four years after the implementation of the national HPV vaccination programme, and three years after the previous survey. Overall, the school nurses had more favourable attitudes towards the HPV vaccination programme compared to the study in 2013 (p = 0.015). More than half of the nurses (n = 415, 56%) strongly agreed that boys should also be offered the vaccine (p<0.001). There were no differences in school nurses' perceived knowledge about HPV in order to inform and to answer questions about the vaccine from the girls or from the parents. More than half of the nurses (n = 409, 56%) reported that they needed more education about HPV. Almost all nurses (n = 659, 90%) had been contacted by parents with questions about the vaccine, and most questions were related to vaccine safety. School nurses have a more favourable attitude towards the vaccination programme against HPV compared to three years earlier, although almost all nurses had been contacted by parents with diverse questions and concerns. The nurses believed that they needed more education about HPV. Thus, it is essential to provide ongoing education and training for school nurses who are key healthcare professionals for providing information about HPV and HPV vaccination to parents and to pupils.

Keywords
Human-papillomavirus, provider communication, professional practice, hesitancy, knowledge, parents, trust
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-322806 (URN)10.1371/journal.pone.0175883 (DOI)000399875200050 ()28419156 (PubMedID)
Available from: 2017-09-13 Created: 2017-09-13 Last updated: 2019-10-18Bibliographically approved
Grandahl, M., Tydén, T., Westerling, R., Nevéus, T., Rosenblad, A., Hedin, E. & Oscarsson, M. (2017). To Consent or Decline HPV Vaccination: A Pilot Study at the Start of the National School-Based Vaccination Program in Sweden. Journal of School Health, 87(1), 62-70
Open this publication in new window or tab >>To Consent or Decline HPV Vaccination: A Pilot Study at the Start of the National School-Based Vaccination Program in Sweden
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2017 (English)In: Journal of School Health, ISSN 0022-4391, E-ISSN 1746-1561, Vol. 87, no 1, p. 62-70Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Parents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model.

METHODS:

The sample consisted of 200 (55%) parents of children aged 11-12 years in the Swedish national vaccination program. Data were collected using a self-reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi-square, Fisher's exact test, and the Mann-Whitney U test were used to analyze data.

RESULTS:

Declining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners.

CONCLUSION:

Parents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence-based information on the Internet.

Keywords
HPV vaccination; Health Belief Model; health beliefs; school nurses; school-based vaccination programs
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-308992 (URN)10.1111/josh.12470 (DOI)000393826900008 ()27917484 (PubMedID)
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2019-10-18Bibliographically approved
Grandahl, M., Rosenblad, A., Stenhammar, C., Tydén, T., Westerling, R., Larsson, M., . . . Neveus, T. (2016). School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study. BMJ Open, 6(1), Article ID e009875.
Open this publication in new window or tab >>School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study
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2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 1, article id e009875Article in journal (Refereed) Published
Abstract [en]

Objective: To improve primary prevention of human papillomavirus (HPV) infection by promoting vaccination and increased condom use among upper secondary school students. Design: Cluster randomised controlled trial. Setting: 18 upper secondary schools in Sweden. Participants: Schools were first randomised to the intervention or the control group, after which individual classes were randomised so as to be included or not. Of the 832 students aged 16 years invited to participate during the regular individual health interview with the school nurse, 751 (90.2%) agreed to participate and 741 (89.1%) students completed the study. Interventions: The intervention was based on the Health Belief Model (HBM). According to HBM, a person's health behaviour can be explained by individual beliefs regarding health actions. School nurses delivered 30 min face-to-face structured information about HPV, including cancer risks and HPV prevention, by propagating condom use and HPV vaccination. Students in the intervention and the control groups completed questionnaires at baseline and after 3 months. Main outcome measures: Intention to use condom with a new partner and beliefs about primary prevention of HPV, and also specifically vaccination status and increased condom use. Results: All statistical analyses were performed at the individual level. The intervention had a significant effect on the intention to use condom (p=0.004). There was also a significant effect on HBM total score (p=0.003), with a 2.559 points higher score for the intervention group compared to the controls. The influence on the HBM parameters susceptibility and severity was also significant (p<0.001 for both variables). The intervention also influenced behaviour: girls in the intervention group chose to have themselves vaccinated to a significantly higher degree than the controls (p=0.02). No harms were reported. Conclusions: The school-based intervention had favourable effects on the beliefs about primary prevention of HPV, and increased the HPV vaccination rates in a diverse population of adolescents.

Keywords
adolescents, HPV, prevention, randomised control trial, school-based
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-263257 (URN)10.1136/bmjopen-2015-009875 (DOI)000369993900136 ()
Funder
Swedish Cancer Society, 130744
Available from: 2015-09-30 Created: 2015-09-29 Last updated: 2019-10-18Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4553-6656

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